Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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BACKGROUND: Mesenchymal stromal cell (MSC) transplantation therapy is a promising therapy for stroke patients. In parallel, rehabilitation with physical exercise could ameliorate stroke-induced neurological impairment. In this study, we aimed to clarify whether combination therapy of intracerebral transplantation of human modified bone marrow-derived MSCs, SB623 cells, and voluntary exercise with running wheel (RW) could exert synergistic therapeutic effects on a rat model of ischemic stroke. METHODS: Wistar rats received right transient middle cerebral artery occlusion (MCAO). Voluntary exercise (Ex) groups were trained in a cage with RW from day 7 before MCAO. SB623 cells (4.0 × 105 cells/5 μl) were stereotactically injected into the right striatum at day 1 after MCAO. Behavioral tests were performed at day 1, 7, and 14 after MCAO using the modified Neurological Severity Score (mNSS) and cylinder test. Rats were euthanized at day 15 after MCAO for mRNA level evaluation of ischemic infarct area, endogenous neurogenesis, angiogenesis, and expression of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF). The rats were randomly assigned to one of the four groups: vehicle, Ex, SB623, and SB623 + Ex groups. RESULTS: SB623 + Ex group achieved significant neurological recovery in mNSS compared to the vehicle group (p < 0.05). The cerebral infarct area of SB623 + Ex group was significantly decreased compared to those in all other groups (p < 0.05). The number of BrdU/Doublecortin (Dcx) double-positive cells in the subventricular zone (SVZ) and the dentate gyrus (DG), the laminin-positive area in the ischemic boundary zone (IBZ), and the mRNA level of BDNF and VEGF in SB623 + Ex group were significantly increased compared to those in all other groups (p < 0.05). CONCLUSIONS: This study suggests that combination therapy of intracerebral transplantation SB623 cells and voluntary exercise with RW achieves robust neurological recovery and synergistically promotes endogenous neurogenesis and angiogenesis after cerebral ischemia, possibly through a mechanism involving the up-regulation of BDNF and VEGF.

DOI： 10.1186/s13287-023-03236-4

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Diffusely infiltrative midline gliomas are known to have a poor prognosis. The standard treatment for typical diffuse midline glioma in the pons is local radiotherapy as surgical resection is inappropriate. This case reports a brainstem glioma in which stereotactic biopsy and foramen magnum decompression were concomitantly performed to confirm the diagnosis and improve symptoms. A 23-year-old woman was referred to our department with a chief complaint of headache for six months. Magnetic resonance imaging (MRI) showed diffuse T2 hyperintense swelling of the brainstem with the pons as the main locus. Enlargement of the lateral ventricles was observed because of cerebrospinal fluid obstruction out of the posterior fossa. This was atypical for a diffuse midline glioma in terms of the longstanding slow progression of symptoms and patient age. Stereotactic biopsy was performed for diagnosis, and foramen magnum decompression (FMD) was concomitantly performed to treat the obstructive hydrocephalus. The histological diagnosis was astrocytoma, IDH-mutant. Post-surgery, the patient's symptoms were relieved, and she was discharged on the fifth day after surgery. The hydrocephalus was resolved, and the patient returned to normal life without any symptoms. The tumor size follow-up with MRI demonstrated no marked change for 12 months. Even though diffuse midline glioma is considered to have a poor prognosis, clinicians should contemplate if it is atypical. In atypical cases like the one described herein, surgical treatment may contribute to pathological diagnosis and symptom improvement.

DOI： 10.2176/jns-nmc.2022-0159

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BACKGROUND: Vagus nerve stimulation (VNS) exerts neuroprotective and anti-inflammatory effects in preclinical models of central nervous system disorders, including Parkinson's disease (PD). VNS setting applied for experimental models is limited into single-time or intermittent short-duration stimulation. We developed a VNS device which could deliver continuous stimulation for rats. To date, the effects of vagal afferent- or efferent-selective stimulation on PD using continuous electrical stimulation remains to be determined. OBJECTIVE: To investigate the effects of continuous and selective stimulation of vagal afferent or efferent fiber on Parkinsonian rats. METHODS: Rats were divided into 5 group: intact VNS, afferent VNS (left VNS in the presence of left caudal vagotomy), efferent VNS (left VNS in the presence of left rostral vagotomy), sham, vagotomy. Rats underwent the implantation of cuff-electrode on left vagus nerve and 6-hydroxydopamine administration into the left striatum simultaneously. Electrical stimulation was delivered just after 6-OHDA administration and continued for 14 days. In afferent VNS and efferent VNS group, the vagus nerve was dissected at distal or proximal portion of cuff-electrode to imitate the selective stimulation of afferent or efferent vagal fiber respectively. RESULTS: Intact VNS and afferent VNS reduced the behavioral impairments in cylinder test and methamphetamine-induced rotation test, which were accompanied by reduced inflammatory glial cells in substantia nigra with the increased density of the rate limiting enzyme in locus coeruleus. In contrast, efferent VNS did not exert any therapeutic effects. CONCLUSION: Continuous VNS promoted neuroprotective and anti-inflammatory effect in experimental PD, highlighting the crucial role of the afferent vagal pathway in mediating these therapeutic outcomes.

DOI： 10.1016/j.brs.2023.03.003

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient's symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation.

DOI： 10.18926/AMO/64124

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Cortical tubers are one of the typical intracranial manifestations of tuberous sclerosis complex (TSC). Multiple cortical tubers are easy to diagnose as TSC; however, a solitary cortical tuber without any other cutaneous or visceral organ manifestations can be confused with other conditions, particularly focal cortical dysplasia. We report a surgical case of refractory epilepsy caused by a solitary cortical tuber mimicking focal cortical dysplasia type II, and describe the radiological, electrophysiological, and histopathological findings of our case.

DOI： 10.18926/AMO/63742

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Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

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Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

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Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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A 3-year-old boy had difficulty sitting up and walking for several months. Magnetic resonance imaging (MRI) revealed an intradural tumor at the L3-4 level. The tumor was successfully resected by unilateral hemilaminectomy and diagnosed as dermoid cyst. The patient had an uneventful postoperative course without pain, and MRI found no recurrence after surgery. A small bone defect remained that might be favorably reconstructed with autologous and artificial bone. Hemilaminectomy allowed us to resect the cauda equina dermoid cyst with minimal invasiveness. Pediatric patients require follow-up as they are more likely to experience spinal deformity or instability after surgery.

DOI： 10.18926/AMO/63426

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Early-onset isolated (DYT1) dystonia is one of the most common forms of primary dystonia in childhood, and deep brain stimulation of the globus pallidus internus (GPi-DBS) is a highly effective treatment for it. However, the effectiveness of GPi-DBS in monozygotic twins with DYT1 dystonia has never been reported globally. Here, we report the cases of monozygotic twins with DYT1 dystonia who were treated using GPi-DBS, and we include a literature review. The younger brother showed an abnormal gait, with external rotation of the right lower leg at 6 years old. The symptoms gradually became so severe that he had difficulty walking on his own at 9 years of age. Treatment with levodopa-carbidopa partially resolved his symptoms, but most of the symptoms remained. Meanwhile, the older brother developed dystonia in both upper limbs at 8 years of age, with gradual symptom progression. At 13 years of age, they were diagnosed with DYT1 dystonia. Bilateral GPi-DBS was performed in both patients at 16 years of age. Their symptoms remarkably improved after surgery. The Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement score was reduced from 52 to 2 points for the younger brother and from 35 to 1 point for the older brother. Even if monozygotic twins have the same genes, the onset and severity of symptoms might vary in accordance with differences in epigenomic profiles. However, GPi-DBS treatment was very effective for the two cases; thus, we should consider the surgical interventions for each patient.

DOI： 10.2176/jns-nmc.2022-0084

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Accurate diagnosis is important for lumbar degenerative diseases. Patients' history, neurological examination, and diagnostic imaging are the three pillars for accurate diagnosis. While collecting medical history, 5W1H of the symptoms should be considered. Muscle strength, pain and numbness, and deep tendon reflex are the basic parameters in the neurological examination. A combination of the results of each tool is needed to facilitate precise diagnosis. This should be followed by diagnostic imaging to confirm the diagnosis. We feel relieved when neurological examination and diagnostic imaging reveals congruent results. The symptoms of lumbar degenerative diseases are the results of[static factors: the stenosis of the canal/intervertebral foramen]×[dynamic factor: the instability]. The T2-weighted MRI images effectively reveal canal/intervertebral foramen stenosis. Short-T1 inversion recovery(STIR)of MRI reveals early fractures and inflammation of the spine. CT findings help to imagine the process of drilling and screw insertion. A whole spine X-ray is good to reveal spinal alignment. Roentogenkymography with anteflexion/retroflexion reveals the instability of the lumbar spine. Myelography is effective in knowing the cerebrospinal fluid flow in a standing position. Therefore, accurate diagnosis and careful treatment are needed to obtain the appropriate outcome for a prolonged period after spinal surgery.

DOI： 10.11477/mf.1436204510

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We developed a new cranioplasty method that utilizes artificial bone made of ultra-high-molecular-weight polyethylene, with a wedge-shaped edge (UHMWPE Wing). This study shows the methods and data of case series and finite element analyses with the UHMWPE Wing. A circumferential wing was preoperatively designed for a custom-made artificial bone made of UHMWPE to achieve high fixed power and to minimize the usage of cranial implants. Here, we present 4 years of follow-up data and finite element analyses for patients treated with the UHMWPE Wing between February 2015 and February 2019. Eighteen consecutive patients underwent cranioplasty using our UHMWPE Wing design. There were no postoperative adverse events in 17 of the patients for at least 18 months. One case of hydrocephalus experienced screw loosening and graft uplift due to shunt malfunction. Placement of a ventriculo-peritoneal shunt immediately returned the artificial bone to normal position. Finite element analyses revealed that a model using the UHMWPE Wing had the highest withstand load and lowest deformation. This is the first report on the UHMWPE Wing method. This method may enable clinicians to minimize dead space and achieve high strength in cranioplasty.

DOI： 10.2176/nmc.oa.2021-0032

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OBJECTIVES: The relationship between stroke etiology and clot pathology remains controversial. MATERIALS AND METHODS: We performed histological analysis of clots retrieved from 52 acute ischemic stroke patients using hematoxylin and eosin staining and immunohistochemistry (CD42b and oxidative/hypoxic stress markers). The correlations between clot composition and the stroke etiological group (i.e., cardioembolic, cryptogenic, or large artery atherosclerosis) were assessed. RESULTS: Of the 52 clots analyzed, there were no significant differences in histopathologic composition (e.g., white blood cells, red blood cells, fibrin, and platelets) between the 3 etiological groups (P = .92). By contrast, all large artery atherosclerosis clots showed a localized pattern with the oxidative stress marker 4-hydroxyl-2-nonenal (P < .01). From all 52 clots, 4-hydroxyl-2-nonenal expression patterns were localized in 28.8% of clots, diffuse in 57.7% of clots, and no signal in 13.5% of clots. CONCLUSIONS: A localized pattern of 4-hydroxyl-2-nonenal staining may be a novel and effective marker for large artery atherosclerosis (sensitivity 100%, specificity 82%).

DOI： 10.1016/j.jstrokecerebrovasdis.2020.105583

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Ossification of the posterior longitudinal ligament (OPLL) is common in East Asia. Arteriovenous fistula at the craniocervical junction (CCJ-AVF), in contrast, is rare. As OPLL occurs most often in the cervical region, these 2 conditions can coexist in the cervical spinal canal of a single patient. We report a case of CCJ-AVF found after cervical laminoplasty (CLP) for OPLL. A 68-year-old man experienced progressive myelopathy due to cervical OPLL. Magnetic resonance imaging (MRI) revealed a high-intensity area inside the spinal cord. CLP was performed and his symptoms immediately improved. Three months after CLP, however, myelopathy recurred. MRI revealed an exacerbated and enlarged high-intensity area inside the cord from the medulla oblongata to the C4/5 level with a flow void around the cord. Left vertebral artery angiography revealed CCJ-AVF with ascending and descending draining veins. Direct surgery was performed to interrupt shunt flow into the draining veins. The patient's symptoms improved to a limited degree. In this case, increased pressure inside the spinal canal due to OPLL might have decreased the shunt flow of the CCJ-AVF. Thus, the venous congestion induced by CCJ-AVF might have been exacerbated after the pressure was removed by CLP. Magnetic resonance angiography screening could help detect concurrent CCJ-AVF and OPLL.

DOI： 10.14245/ns.2040200.100

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BACKGROUND: Details of the somatotopy within the subthalamic nucleus (STN) are still poorly understood; however, the STN is a common target of deep brain stimulation (DBS) for Parkinson disease. OBJECTIVE: To examine somatotopic organization within the STN and identify optimal stimulation sites from 77 surgical cases with microelectrode recording. METHODS: STN-DBS was performed for 77 patients with Parkinson disease between 2010 and 2014. We performed passive movements of each joint and captured single neuronal activities to identify movement-related cells (MRCs). The sites of MRCs and active contacts were determined by measuring their distances from the first contact of DBS electrode. Their positional correlations were directly and indirectly analyzed. RESULTS: The number of obtained MRCs was 264, of which 151 responded to multiple joints. The average x-, y-, and z-coordinates of the cells of the upper and lower limbs from the midcommisural point were 13.1 ± 1.1 and 12.7 ± 1.2, 0.22 ± 1.3 and -0.45 ± 1.5, and -2.5 ± 1.1 and -3.0 ± 1.4 mm, respectively. Most MRCs were distributed in the upper third of the STN, in its superior, lateral, and posterior regions, along the DBS electrode routes. Active contacts were observed to lie slightly inferior, medial, and posterior to the average MRC position. CONCLUSION: Somatotopic organization of the STN was easier to observe in the present study than in previous studies. Optimal stimulation sites were located inferior, medial, and posterior to the average MRC location. The sites may correspond to associative or motor parts through which fibers from the supplementary motor area pass.

DOI： 10.1093/ons/opy351

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The success of deep brain stimulation (DBS) depends heavily on surgical accuracy, and brain shift is recognized as a significant factor influencing accuracy. We investigated the factors associated with surgical accuracy and showed the effectiveness of a dural sealant system for preventing brain shift in 32 consecutive cases receiving DBS. Thirty-two patients receiving DBS between March 2014 and May 2015 were included in this study. We employed conventional burr hole techniques for the first 18 cases (Group I) and a dural sealant system (DuraSeal) for the subsequent 14 cases (Group II). We measured gaps between the actual positions of electrodes and the predetermined target positions. We then retrospectively evaluated the factors involved in surgical accuracy. The average gap between an electrode's actual and target positions was 1.55 ± 0.83 mm in all cases. Postoperative subdural air volume e, the only factor associated with surgical accuracy (r = 0.536, P < 0.0001), was significantly smaller in Group II (Group I: 43.9 ± 27.7, Group II: 12.1 ± 12.5 ml, P = 0.0006). The average electrode position gap was also significantly smaller in Group II (Group I: 1.77 ± 0.91, Group II: 1.27 ± 0.59 mm, P = 0.035). Use of a dural sealant system could significantly reduce intracranial air volume, which should improve surgical accuracy.

DOI： 10.2176/nmc.oa.2017-0242

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The spinal extradural arachnoid cyst is a rare entity. Obtaining the correct diagnosis and detecting the fistula location are critical for providing effective treatment. A 41-year-old man had numbness in the soles of his feet for 2 years with accompanying gait disturbance, and a defecation disorder. Computed tomography myelography performed at another hospital revealed an epidural arachnoid cyst from Th11 to L2. He received a subarachnoid-cyst shunt at the rostral part of the cyst. However, his symptoms worsened and he was admitted to our hospital. Neuroradiological investigations revealed the correct location of the fistula at the level of Th12. We performed partial removal of the cyst wall with fistula closure via right hemilaminectomy of Th11 and 12. The complete closure of the fistula was confirmed by intrathecal infusion of artificial cerebrospinal fluid through the shunt tube. The shunt tube was removed with the sutures. The patient's symptoms improved, although numbness remained in his bilateral heels. There has been no recurrence in 15 months since the surgery. Fistula closure may work as a balanced therapeutic strategy for spinal extradural arachnoid cyst, and intrathecal cerebrospinal fluid infusion is useful for the confirmation of complete fistula closure.

DOI： 10.18926/AMO/55666

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Several targets and targeting methods are utilized in stereotactic surgery to achieve tremor suppression for patients with intractable tremor. Recent developments in magnetic resonance imaging, including diffusion tensor imaging, have enabled the setting of appropriate targets in stereotactic surgery. In this retrospective study, the optimal target to suppress tremors in stereotactic surgery was explored using diffusion tensor image-based fiber tractography. Four tracts were focused on in this study, namely: the cerebello-thalamo-premotor cortical fiber tract, cerebello-thalamo-primary motor cortical fiber tract, spino-thalamo-somatosensory cortical fiber tract, and pyramidal tract. In 10 patients with essential tremor, we evaluated the thalamotomy lesions and active contacts of the lead in thalamic stimulation by diffusion tensor image-based fiber tractography to reveal which part of the cerebral cortex is most affected by stereotactic surgery. Tremor suppression and adverse events were also evaluated in the patients involved in this study. Consequently, the good tremor suppression was achieved in all patients. There had been no permanent adverse events 3 months after surgery. Twelve lesions in thalamotomy patients or active contacts of the lead in thalamic stimulation patients were on the cerebello-thalamo-premotor cortical fiber tract (12/14 lesions or active contacts: 86%). In conclusion, the cerebello-thalamo-premotor cortical fiber tract may be an optimal target for tremor suppression. Diffusion tensor image-based fiber tractography may enable us to both determine the optimal target to achieve strong tremor suppression and to reduce the number of adverse events by keeping lesions or electrodes away from important fiber tracts, such as the pyramidal tract and spinothalamic fibers.

DOI： 10.2176/nmc.oa.2016-0277

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Unexpected injuries can have a profound effect on a surgeon's performance and thus on patients and surgical departments. Here we describe a technique for performing surgery in the standing position, as done by a surgeon with an Achilles tendon rupture. During his prescribed 45-day non-weight-bearing period for the left ankle after surgery for an Achilles tendon rupture, the surgeon was able to participate in 15 surgeries as an operator or assistant, due to his use of a combination of injured-leg genuflection on a stool and a 'Surgical Body Support' device. Similarly injured surgeons may benefit from such support.

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The high mobility group box-1 (HMGB1) exists as an architectural nuclear protein in the normal state, but displays an inflammatory cytokine-like activity in the extracellular space under pathological condition. Inflammation in the pathogenesis of Parkinson's disease (PD) has been documented. In this study, we investigated the involvement of HMGB1 in the pathology and the neuroprotective effects of neutralizing anti-HMGB1 monoclonal antibody (mAb) on an animal model of PD. Adult female Sprague-Dawley rats were initially injected with 6-hydroxydopmaine (6-OHDA, 20 μg/4 μl) into the right striatum, then anti-HMGB1 mAb (1 mg/kg), or control mAb was intravenously administered immediately, at 6 and 24 h after 6-OHDA injection. The treatment with anti-HMGB1 mAb significantly preserved dopaminergic neurons in substantia nigra pars compacta and dopaminergic terminals inherent in the striatum, and attenuated PD behavioral symptoms compared to the control mAb-treated group. HMGB1 was retained in the nucleus of neurons and astrocytes by inhibiting the proinflammation-induced oxidative stress in the anti-HMGB1 mAb-treated group, whereas HMGB1 translocation was observed in neurons at 1 day and astrocytes at 7 days after 6-OHDA injection in the control mAb-treated group. Anti-HMGB1 mAb inhibited the activation of microglia, disruption of blood-brain-barrier (BBB), and the expression of inflammation cytokines such as IL-1β and IL-6. These results suggested that HMGB1 released from neurons and astrocytes was at least partly involved in the mechanism and pathway of degeneration of dopaminergic neurons induced by 6-OHDA exposure. Intravenous administration of anti-HMGB1 mAb stands as a novel therapy for PD possibly acting through the suppression of neuroinflammation and the attenuation of disruption of BBB associated with the disease.

DOI： 10.1016/j.expneurol.2015.11.003

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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OBJECTIVE: Intra-arterial stem cell transplantation exerts neuroprotective effects for ischemic stroke. However, the optimal therapeutic time window and mechanisms have not been completely understood. In this study, we investigated the relationship between the timing of intra-arterial transplantation of allogeneic mesenchymal stem cells (MSCs) in ischemic stroke model in rats and its efficacy in acute phase. METHODS: Adult male Wistar rats weighing 200 to 250 g received right middle cerebral artery occlusion (MCAO) for 90 minutes. MSCs (1 × 10(6) cells/ 1 ml PBS) were intra-arterially injected at either 1, 6, 24, or 48 hours (1, 6, 24, 48 h group) after MCAO. PBS (1 ml) was intra-arterially injected to control rats at 1 hour after MCAO. Behavioral test was performed immediately after reperfusion, and at 3, 7 days after MCAO using the Modified Neurological Severity Score (mNSS). Rats were euthanized at 7 days after MCAO for evaluation of infarct volumes and the migration of MSCs. In order to explore potential mechanisms of action, the upregulation of neurotrophic factor and chemotactic cytokine (bFGF, SDF-1α) induced by cell transplantation was examined in another cohort of rats that received intra-arterial transplantation at 24 hours after recanalization then euthanized at 7 days after MCAO for protein assays. RESULTS: Behavioral test at 3 and 7 days after transplantation revealed that stroke rats in 24h group displayed the most robust significant improvements in mNSS compared to stroke rats in all other groups (p's<0.05). Similarly, the infarct volumes of stroke rats in 24h group were much significantly decreased compared to those in all other groups (p's<0.05). These observed behavioral and histological effects were accompanied by MSC survival and migration, with the highest number of integrated MSCs detected in the 24h group. Moreover, bFGF and SDF-1α levels of the infarcted cortex were highly elevated in the 24h group compared to control group (p's<0.05). CONCLUSIONS: These results suggest that intra-arterial allogeneic transplantation of MSCs provides post-stroke functional recovery and reduction of infarct volumes in ischemic stroke model of rats. The upregulation of bFGF and SDF-1α likely played a key mechanistic role in enabling MSC to afford functional effects in stroke. MSC transplantation at 24 hours after recanalization appears to be the optimal timing for ischemic stroke model, which should guide the design of clinical trials of cell transplantation for stroke patients.

DOI： 10.1371/journal.pone.0127302

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Language：Japanese   Publisher：The Japanese Society of Spinal Surgery  

DOI： 10.2531/spinalsurg.29.77

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Other Link： http://search.jamas.or.jp/link/ui/2015237853

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OBJECTIVE: We wished to relate severity of Parkinson's disease (PD) with cognitive function in relation to cerebral blood flow (CBF). METHODS: Eighty-one consecutive PD patients were enrolled in this study. We used Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-Third edition (WAIS-III) to evaluate cognitive functions, and three-dimensional stereotactic ROI template (3DSRT) and Statistical Parametric Mapping (SPM) 8 to evaluate single photon emission CT (SPECT) recordings of regional CBF. RESULTS: The mean MMSE score of PD patients was 27.4 ± 2.4. The scores of most patients were higher than 23/30. On the other hand, the mean Full-scale IQ of PD patients was 88.4 ± 17.3 in WAIS-III, which was lower than that of normal controls. In particular, visuospatial function score of most patients was lower. There was significant correlation between cognitive scores and Hoehn & Yahr stage and hallucinatory episodes. PD Patients with stage III and IV showed significant deterioration in cognitive functions compared to stage II patients. Analysis of CBF revealed relative reductions in perfusion in the cerebral cortex relative to that in normal control. SPM 8 showed that cognitive functions in PD patients were positively correlated with rCBF in the thalamus and cingulate gyrus. CONCLUSIONS: This is the study to demonstrate the cognitive impairments in PD patients using WAIS-III. Visuospatial dysfunction might be caused by decrease in rCBF in the parietal and occipital lobes and dorsolateral prefrontal cortex. The severity of cognitive impairments in PD patients was correlated with disease severity and hallucinatory episodes.

DOI： 10.1016/j.parkreldis.2014.01.002

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In clinical practice, deep brain stimulation (DBS) is effective for treatment of motor symptoms in Parkinson's disease (PD). However, the mechanisms have not been understood completely. There are some reports that electrical stimulation exerts neuroprotective effects on the central nervous system diseases including cerebral ischemia, head trauma, epilepsy and PD, although there are a few reports on neuroprotective effects of spinal cord stimulation (SCS). We investigated the neuroprotective effects of high cervical SCS on PD model of rats. Adult female Sprague-Dawley rats received hour-long SCS (2, 50 or 200 Hz) with an epidural electrode at C1-2 level for 16 consecutive days. At 2 days after initial SCS, 6-hydroxydopamine (6-OHDA) was injected into the right striatum of rats. Behavioral evaluations of PD symptoms were employed, including cylinder test and amphetamine-induced rotation test performed at 1 and 2 weeks after 6-OHDA injection. Animals were subsequently euthanized for immunohistochemical investigations. In order to explore neurotrophic and growth factor upregulation induced by SCS, another cohort of rats that received 50 Hz SCS was euthanized at 1 and 2 weeks after lesion for protein assays. Behavioral tests revealed that the number of amphetamine-induced rotations decreased in SCS groups. Immunohistochemically, tyrosine hydroxylase (TH)-positive fibers in the striatum were significantly preserved in SCS groups. TH-positive neurons in the substantia nigra pars compacta were significantly preserved in 50 Hz SCS group. The level of vascular endothelial growth factor (VEGF) was upregulated by SCS at 1 week after the lesion. These results suggest that high cervical SCS exerts neuroprotection in PD model of rats, at least partially by upregulation of VEGF. SCS is supposed to suppress or delay PD progression and might become a less invasive option for PD patients, although further preclinical and clinical investigations are needed to confirm the effectiveness and safety.

DOI： 10.1371/journal.pone.0101468

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Epilepsy is a chronic neurological disorder, which presents with various forms of seizures. Traditional treatments, including medication using antiepileptic drugs, remain the treatment of choice for epilepsy. Recent development in surgical techniques and approaches has improved treatment outcomes. However, several epileptic patients still suffer from intractable seizures despite the advent of the multimodality of therapies. In this article, we initially provide an overview of clinical presentation of epilepsy then describe clinically relevant animal models of epilepsy. Subsequently, we discuss the concepts of regenerative medicine including cell therapy, neuroprotective agents, and electrical stimulation, which are reviewed within the context of our data.

DOI： 10.3390/ijms141223390

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The number of diabetes mellitus (DM) patients is increasing, and stroke is deeply associated with DM. Recently, neuroprotective effects of glucagon-like peptide-1 (GLP-1) are reported. In this study, we explored whether liraglutide, a GLP-1 analogue exerts therapeutic effects on a rat stroke model. Wistar rats received occlusion of the middle cerebral artery for 90 min. At one hour after reperfusion, liraglutide or saline was administered intraperitoneally. Modified Bederson's test was performed at 1 and 24 h and, subsequently, rats were euthanized for histological investigation. Peripheral blood was obtained for measurement of blood glucose level and evaluation of oxidative stress. Brain tissues were collected to evaluate the level of vascular endothelial growth factor (VEGF). The behavioral scores of liraglutide-treated rats were significantly better than those of control rats. Infarct volumes of liraglutide-treated rats at were reduced, compared with those of control rats. The level of derivatives of reactive oxygen metabolite was lower in liraglutide-treated rats. VEGF level of liraglutide-treated rats in the cortex, but not in the striatum significantly increased, compared to that of control rats. In conclusion, this is the first study to demonstrate neuroprotective effects of liraglutide on cerebral ischemia through anti-oxidative effects and VEGF upregulation.

DOI： 10.3390/ijms141121513

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：日本老年脳神経外科学会  

過去2年間の80歳以上の超高齢者脊椎脊髄に対する外科治療症例18例(男性11例、女性7例、80〜89歳、中央値86歳)を対象に、患者背景、症状、治療、周術期の問題点、対策について検討を行った。初診時は全例が生活に重大な問題を生じており、8例は独歩不能であった。治療は頸椎病変11例全例に頸椎椎弓形成術、胸髄腫瘍1例に腫瘍摘出術、腰椎変性疾患は5例に片側進入両側開窓術、1例に後方腰椎椎体間固定術を行った。譫妄には抑肝散、食欲不振には六君子湯を用いた。術後、重篤な合併症なく17例で症状改善が得られた。

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

【背景】最近、ventro oralis posterior nucleus(VOP)やposterior subthalamic area(PSA)を標的にした難治性振戦に対する治療の有効性が報告されている。当科でも、難治性振戦に対してPSAを標的とした手術を行っており、この部位の手術に関するdiffusion tensor imaging based fiber tractography(DTI-FT)による解析を試みた。【目的】PSAにおける神経線維の走行を解析し、難治性振戦に対する最適な標的について検討する。【方法】2013年7月から2014年10月までに難治性振戦に対する脳深部刺激療法を行った患者を対象とした。男性2名、女性2名、平均年齢は69.8歳(66〜75歳)であった。術前に3T-MRIでナビゲーション用の画像と共にDTIも撮像した。術中にVIM(ventro intermedial neucleus)、PSA刺激を行い、振戦抑制効果の高い部位に電極を留置した。Stealth Navigation StealthViz上で術前MRI、fiber tractography、術後MRIのfusion画像を作成し、視床VL(ventro lateral)核、PSA(posterior subthalamic area)周囲を走行する神経線維と活動電極の位置関係について検討を行った。【結果】全例で良好な振戦の抑制が得られた。DTI-FTで、視床VL核、PSAを通過する神経線維を明瞭に描出することが可能であった。活動電極はDTI-FTから想定される視床VL核およびPSAを走行する神経線維上にあった。【結論】難治性振戦に対する定位脳手術の標的決定において、DTI-FTは有用であることが示唆された。(著者抄録)

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Language：Japanese   Publisher：The Japanese Society of Spinal Surgery  

Spinal hemangioblastomas are benign, and total surgical resection is the standard treatment method used. However, hypervascular tumors may have excessive operative blood loss if the tumors are divided. We encountered a case of cauda equina hemangioblastoma with extraordinary blood supply, which was treated with preoperative embolization. A 49-year-old woman with von Hippel-Lindau disease who had undergone multiple surgeries for intracranial/extracranial hemangioblastomas had lumbago and leg pain. Magnetic resonance images revealed intradural spinal tumors at the L4-S1 vertebral level, with remarkable gadolinium enhancement. The patient was referred to our hospital, after a plan of total resection had been abandoned elsewhere because of the high flow feeders and high pressure of the tumors. Preoperative embolization was performed with consequent disappearance of the arterial blood supply to the tumor. Two days later, the tumor was resected subtotally with reduced tension and a little blood loss. The patient's symptoms resolved soon after surgery. Selective preoperative embolization for a spinal hemangioblastoma with a rich blood supply is a valid option as an adjuvant to the complete surgical resection of a tumor.

DOI： 10.2531/spinalsurg.29.53

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Other Link： http://search.jamas.or.jp/link/ui/2015281939

Language：Japanese   Publisher：The Japanese Society of Cerebral Blood Flow and Metabolism  

In epileptic encephalopathy, epileptic activity itself may contribute to severe cognitive and behavioral impairments, and it is a case in severe epilepsies in infancy and early childhood. Epilepsies caused by cortical dysplasia are intractable and hence surgical treatment is recommended for them during early childhood when brain functional plasticity is still expected. MRI is generally difficult to interpret because of poor contrast in infancy. Therefore positron emission tomography (PET) and single photon emission computed tomography (SPECT) are useful to identify seizure focus, and SISCOM (Subtraction Ictal SPECT CO-registered to MRI) is particularly important. Eight patients with severe epilepsies underwent a hemispherectomy during infancy and early childhood at the Epilepsy Center of Okayama University Hospital. In two patients, MRI showed uncertain abnormalities, and SISCOM and PET disclosed pathological cortical regions, demonstrating the validity of functional neuroimaging techniques related to brain circulation and metabolism in the evaluation of very young candidate patients for epilepsy surgery.

DOI： 10.16977/cbfm.26.2_163

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Language：Japanese   Publisher：日本定位・機能神経外科学会事務局  

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Other Link： https://search.jamas.or.jp/link/ui/2016123797

Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2015166907

Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

【目的】パーキンソン病(PD)患者の認知機能低下は非運動症状の中でも出現頻度が高く、状態把握が重要である。視床下核刺激療法を施行するPD患者の認知機能について検討を行った。【対象と方法】PD患者51名(男性21名、女性30名)を対象とした。平均年齢は63.9±7.3歳、平均罹病期間は12.2±5.8年であった。認知機能評価にMini-Mental State Examination(MMSE)とWechsler Adult Intelligence Scale-III(WAIS-III)、脳血流SPECTを行った後、three-dimensional stereotaxic ROI template(3DSRT)とStatistical Parametric Mapping(SPM)8を用いて脳血流評価を行った。【結果】MMSEの平均得点は27.1±2.5点、カットオフ以下の患者は51名中5名(9.8%)であった。WAIS-IIIでは全検査IQ、言語性IQ、動作性IQにおいて重症度が増すごとに有意な認知機能低下がみられた。3DSRTではPD患者は一般平均値と比較して前頭葉、側頭葉、頭頂葉、後頭葉の脳血流が低下していた。SPM8ではPD患者の認知機能は視床、帯状回部位の脳血流と相関した。【結語】PD患者の認知機能低下はヤール重症度と相関した。ヤール重症度がIIのPD患者の認知機能は保たれていたが、重症度がIIIとIVのPD患者の言語機能、作動記憶、視空間認知機能は著しく低下していた。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2014281140

Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：(株)金芳堂  

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Language：Japanese   Publisher：日本定位・機能神経外科学会事務局  

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Other Link： https://search.jamas.or.jp/link/ui/2014281138

Language：Japanese   Publisher：日本定位・機能神経外科学会事務局  

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Other Link： https://search.jamas.or.jp/link/ui/2014281148

Language：Japanese   Publisher：日本定位・機能神経外科学会事務局  

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Other Link： https://search.jamas.or.jp/link/ui/2014281139

Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

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Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2022.9.2 - 2022.9.3

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：別府  

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Event date： 2022.9.2 - 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：別府  

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Event date： 2022.7.29 - 2022.7.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：郡山  

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Event date： 2022.7.22 - 2022.7.23

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：金沢  

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Event date： 2022.7.7 - 2022.7.8

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京  

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Event date： 2022.7.2

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2022.6.23

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2022.6.18 - 2022.6.19

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：千葉  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：和歌山  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：和歌山  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Poster presentation  

Venue：和歌山  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Poster presentation  

Venue：和歌山  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：和歌山  

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Event date： 2022.6.16 - 2022.6.17

Language：Japanese   Presentation type：Poster presentation  

Venue：和歌山  

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Event date： 2022.4.23

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：徳島  

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Event date： 2022.4.15 - 2022.4.16

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.19

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.2.25 - 2022.2.26

Language：Japanese   Presentation type：Poster presentation  

Venue：橿原  

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Event date： 2022.2.25 - 2022.2.26

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：橿原  

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Event date： 2022.2.19

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：出雲  

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Event date： 2022.1.28 - 2022.1.29

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.28 - 2022.1.29

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.28 - 2022.1.29

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.28 - 2022.1.29

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：大阪  

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Event date： 2022.1.28 - 2022.1.29

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.27 - 2022.1.28

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：大阪  

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Event date： 2022.1.27 - 2022.1.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.27 - 2022.1.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.27 - 2022.1.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.1.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.12.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.9.24 - 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.9.3 - 2021.9.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.9.3 - 2021.9.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.9.3 - 2021.9.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.9.3 - 2021.9.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.9.3 - 2021.9.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2021.6.3 - 2021.6.4

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：京都  

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Event date： 2021.6.3 - 2021.6.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2020.11.9 - 2020.11.10

Language：English   Presentation type：Symposium, workshop panel (public)  

Venue：Tokyo  

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Event date： 2020.11.9 - 2020.11.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.8.23 - 2020.8.25

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2019.6.20 - 2019.6.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：札幌  

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Event date： 2019.6.20 - 2019.6.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：札幌  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：大阪  

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